| NPI | 1376520114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: CA G52928) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G52928) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G52928) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2026-04-29 |