| NPI | 1083928683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-17516) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60539894) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD176759) | |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2026-07-16 |