| NPI | 1558577981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A124082) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD-12596) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60936234) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2022-04-11 |