| NPI | 1568472389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G35245) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G35245) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2016-03-25 |