| NPI | 1487018578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61443065) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A172641) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2025-05-08 |