| NPI | 1881705481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 236737) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C205121) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61617595) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2026-01-19 |