| NPI | 1104923572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0904X Radiology, Nuclear Radiology (Licence: CA A91640) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A91640) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |