| NPI | 1861029951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A23700) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 328114-01) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-08-12 |