| NPI | 1912185075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C127963) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: GA 002243) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2025-09-17 |