| NPI | 1720257744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N2787) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A101272) |
| Enumeration Date | 2008-02-23 |
| Last Update Date | 2011-01-06 |