| NPI | 1104877497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: CA A67310) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A67310) |
| 261QR0200X Clinic/Center, Radiology (Licence: CA A67310) | |
| 261QR0206X Clinic/Center, Radiology, Mammography (Licence: CA A67310) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2022-12-29 |