| NPI | 1619437779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD H0100891) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA DO-06857) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 21575) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2024039730) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU DO-0133) | |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2025-09-23 |