| NPI | 1487858569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M5352) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C143222) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2025-04-08 |