| NPI | 1942823729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A24968) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA 20A24968) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2026-07-01 |