| NPI | 1104192301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 318683) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A130608) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD6084084) | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2025-12-11 |