| NPI | 1386101947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 70115) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A157696) |
| Enumeration Date | 2019-03-01 |
| Last Update Date | 2024-06-10 |