| NPI | 1336139351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G16037) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: CA G16037) |
| 2085N0904X Radiology Nuclear Radiology (Licence: CA G16037) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA G16037) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: CA G16037) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2015-02-16 |