| NPI | 1790163863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A18292) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 341224) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2026-04-30 |