| NPI | 1841553054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A153092) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 281425) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2025-09-18 |