| NPI | 1750815171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S3260) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A175634) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2026-02-09 |