| NPI | 1063878783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A15774) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MB12700100) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.016514) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102207979) | |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2025-10-09 |