| NPI | 1699954065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T4201) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A83971) |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2022-04-06 |