| NPI | 1710509054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A23701) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 1710509054) |
| Enumeration Date | 2020-05-09 |
| Last Update Date | 2025-05-21 |