| NPI | 1831515832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A18149) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 1451) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2026-10-01 |