| NPI | 1508088618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 31652) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A104418) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2019-03-27 |