| NPI | 1518126697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A103564) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: HI MD-16878) |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2023-11-14 |