| NPI | 1982674453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A75574) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: CA A75574) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2010-02-04 |