| NPI | 1619255775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A141194) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A141194) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R8760) | |
| Enumeration Date | 2011-07-23 |
| Last Update Date | 2025-06-06 |