| NPI | 1497780456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A65524) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A65524) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2025-07-03 |