| NPI | 1902260441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A15734) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-00405) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2026-01-15 |