| NPI | 1780172825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S8655) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A184512) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2025-08-07 |