| NPI | 1336600576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A180951) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 28098) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2026-04-01 |