| NPI | 1164719993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301101660) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A142218) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1025761) | |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2026-02-03 |