| NPI | 1962963801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A23020) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV DO3674) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-03-11 |