| NPI | 1598751893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G178182) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 31692) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2024-07-10 |