| NPI | 1225307580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: CA 20A22530) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501015576) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OT019769) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A22530) | |
| 2085N0700X (Licence: CA 20A22530) | |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2025-12-11 |