| NPI | 1992334452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301517562) |
| Additional Taxonomies | 2085N0700X (Licence: CA A200713) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A200713) | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2026-09-02 |