| NPI | 1326256678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C132500) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101245018) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301513500) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036.175933) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2025-08-18 |