| NPI | 1295173250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C206673) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U1895) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2026-04-07 |