| NPI | 1164408993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A92090) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M9398) |
| 2471C3402X Radiologic Technologist, Radiography (Licence: CA A92090) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2021-11-02 |