| NPI | 1881190015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A184274) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101285169) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-04004) | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2026-02-19 |