| NPI | 1508058280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA 60270109) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A106737) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2013-07-25 |