| NPI | 1588293963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1021906) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A183032) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2025-06-30 |