| NPI | 1679825400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 24382) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A87377) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR DO187083) | |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2025-10-06 |