| NPI | 1205090966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 30893) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA 145729) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301092932) | |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2018-10-14 |