| NPI | 1992726707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A68115) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 46462020) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2025-10-14 |