| NPI | 1396057576 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A132901) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME128103) | 
| Enumeration Date | 2010-07-05 | 
| Last Update Date | 2025-09-24 |