| NPI | 1558756882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX W0977) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A165969) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2025-09-23 |