| NPI | 1578764593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 14609) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A110883) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2014-11-05 |