| NPI | 1255569422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 350269) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 23943) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35096509) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 81543) | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2026-03-03 |