| NPI | 1194049965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A137179) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 253520) |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2022-07-21 |