| NPI | 1700963980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A79565) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA A79565) |
| 2085N0904X (Licence: CA A79565) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX u0848) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-03256) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CA A79565) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2024-11-19 |