| NPI | 1255922340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA SPI967) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR PG197896) |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2026-07-09 |