| NPI | 1417450271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: CA 20A20860) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A20860) |
| 2085N0700X (Licence: MO 2024015342) | |
| Enumeration Date | 2018-03-17 |
| Last Update Date | 2025-11-20 |