| NPI | 1205975208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A84730) |
| Additional Taxonomies | 2085N0700X (Licence: NM 2006-0402) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2026-03-16 |