| NPI | 1134566235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A132899) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD478710) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2024-11-18 |