| NPI | 1255418448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G85389) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA G89853) |
| 2085N0700X (Licence: CA G85389) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CA G85389) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2014-04-29 |