| NPI | 1427114602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A42976) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA A42976) |
| 2085N0904X (Licence: CA A42976) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2025-09-11 |