| NPI | 1427071448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NV DO2376) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA 20A 9445) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2022-08-18 |