| NPI | 1427071448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV DO2376) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N6619) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A 9445) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2025-10-03 |