| NPI | 1356516975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A110399) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 224940) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2020-02-10 |