| NPI | 1962649483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA C26760) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA C26760) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2023-11-01 |