| NPI | 1104114651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A124225) |
| Additional Taxonomies | 2085N0700X (Licence: CA A124225) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2026-02-21 |