| NPI | 1912324054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: CA A138890) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A138890) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 54327) | |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2026-04-29 |