| NPI | 1083179964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: CA A196353) |
| Additional Taxonomies | 2084D0003X Psychiatry & Neurology, Diagnostic Neuroimaging (Licence: CA A196353) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61540574) | |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2026-08-25 |