| NPI | 1831374289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A145420) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 190473) |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2018-07-18 |