| NPI | 1700177847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A122771) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CA A122771) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2019-10-24 |