| NPI | 1568633717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 48979) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A108812) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2025-02-24 |