| NPI | 1164511960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085B0100X Radiology Body Imaging (Licence: CA A32707) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A32707) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-08-30 |