| NPI | 1679901656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A22974) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD 00037755) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 4078) | |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2013-10-29 |