| NPI | 1912916008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD157099) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101236649) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C54415) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60275088) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2026-06-17 |