| NPI | 1700981966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: CA C175165) |
| Additional Taxonomies | 2085N0700X (Licence: WA MD60209727) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60209727) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NH RT 1621) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301505566) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2026-06-01 |