| NPI | 1366836553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA a142169) |
| Additional Taxonomies | 2085N0700X (Licence: MI 4301510427) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0026979) | |
| 2085N0700X (Licence: NY 3659068) | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2026-02-27 |