| NPI | 1164630117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C158170) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT MED-PHYS-LIC-121183) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 322316) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD207467) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U2278) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-34422) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME167917) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0065320) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 14213721-1205) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2026-07-15 |