| NPI | 1295797322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A61175) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME172174) |
| 2085B0100X Radiology, Body Imaging (Licence: CA A61175) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2025-12-30 |