| NPI | 1922506633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A184202) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA PTL3893) |
| Enumeration Date | 2018-01-28 |
| Last Update Date | 2025-07-02 |