| NPI | 1326499088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A207175) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: NE 33973) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2026-04-27 |