| NPI | 1154335420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 51213-020) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A 102863) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2008-11-17 |