| NPI | 1265455505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G89384) |
| Additional Taxonomies | 2085N0700X (Licence: NM 86312) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 86312) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2025-09-04 |