| NPI | 1609194851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX Q8977) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA C194260) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2024-06-03 |