| NPI | 1285165183 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 64443) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A178183) | 
| Enumeration Date | 2017-03-22 | 
| Last Update Date | 2023-06-28 |