| NPI | 1336315316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A77707) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: CA A77707) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 041210) | |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2024-11-19 |