| NPI | 1194967760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA 183855) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AR E-6730) |
| Enumeration Date | 2009-03-29 |
| Last Update Date | 2023-01-19 |