| NPI | 1063405777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A 9269) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P0225) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2014-12-19 |