| NPI | 1609083369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A81972) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CA A81972) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A81972) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2008-03-05 |