| NPI | 1588757074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A49092) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A49092) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-09-26 |