| NPI | 1912185075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301517587) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C127963) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP265) | |
| 207U00000X Nuclear Medicine (Licence: GA 002243) | |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2026-08-05 |