| NPI | 1972679959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G73401) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA G73401) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2008-07-17 |