| NPI | 1992725980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2007008859) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A 12034) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2012-05-21 |