| NPI | 1407242985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 21017) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A174024) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2021-07-26 |