| NPI | 1255838256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD61546004) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A164956) |
| Enumeration Date | 2018-04-07 |
| Last Update Date | 2025-05-28 |