| NPI | 1043940455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 48709) |
| Additional Taxonomies | 2085N0700X (Licence: CA PTL8644) |
| 2085N0700X (Licence: TX 48709) | |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2025-08-27 |