| NPI | 1215170790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E7978) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A130490) |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2023-11-17 |