| NPI | 1134382237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A177317) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101286200) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0073916) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2026-04-02 |