| NPI | 1548223670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 10924) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G72056) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 59033) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2015-06-22 |