| NPI | 1104005172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61064494) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 2OA9181) |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2022-01-23 |