| NPI | 1881822682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: CA A114756) |
| Additional Taxonomies | 2085N0700X (Licence: MO 2014008996) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A114756) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2025-04-18 |