| NPI | 1053524363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0024032) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G152002) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 142593) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2026-08-02 |