| NPI | 1073774923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A 109712) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 247140-1) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2026-09-29 |