| NPI | 1184148397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 272956) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A175498) |
| Enumeration Date | 2017-07-29 |
| Last Update Date | 2025-09-10 |