| NPI | 1538180963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301055625) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD463412) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-35666) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2026-03-18 |