| NPI | 1104856145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301056038) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 069045) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME117258) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01071636A) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD045429E) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-058853) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2025-08-18 |