| NPI | 1710115019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 0016388) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C34159) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2009-06-24 |