| NPI | 1356557763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD434410) |
| Additional Taxonomies | 2085N0700X (Licence: PA MD434410) |
| 2085N0700X (Licence: GA 95273) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 95273) | |
| 2085N0700X (Licence: MI 4301081510) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301081510) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2025-11-18 |