| NPI | 1861832230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: CA 20A16474) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101020333) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A16474) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2022-08-05 |