| NPI | 1578982716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A167798) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 92381) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2025-06-26 |