| NPI | 1619311792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A134076) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 11030880-1205) |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2019-04-25 |