| NPI | 1194911800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C194990) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 14792) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2024-10-23 |