| NPI | 1366078396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-00572) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A181454) |
| Enumeration Date | 2020-03-21 |
| Last Update Date | 2025-05-29 |