| NPI | 1043447865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A142791) |
| Additional Taxonomies | 2085N0700X (Licence: CA A142791) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2017-08-23 |