| NPI | 1598060436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P3490) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A104035) |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2025-12-31 |