| NPI | 1821362740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A15777) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 308951) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NV DO2248) | |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2026-09-04 |