| NPI | 1003825878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC MD10345) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: SC MD10345) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: SC MD10345) | |
| 2085N0904X (Licence: SC MD10345) | |
| 2085B0100X Radiology, Body Imaging (Licence: SC MD10345) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC MD10345) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2025-12-04 |