| NPI | 1417111477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A106536) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-14353) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 65366) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2024-05-16 |