| NPI | 1417489758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 69792) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A176662) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2024-12-05 |