| NPI | 1962865303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A21402) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM DO2025-0068) |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2026-04-30 |