| NPI | 1225203151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A118893) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 265592) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R8268) | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2021-09-20 |