| NPI | 1508284514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD471931) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A180071) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2022-08-09 |