| NPI | 1942348883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: NV 6737) |
| Additional Taxonomies | 2085N0700X (Licence: WA MD00021768) |
| 2085N0700X (Licence: CA G44908) | |
| 2085N0700X (Licence: AK AA2622) | |
| 2085N0700X (Licence: MA 58944) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00021768) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G44908) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AK AA2622) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 58944) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 6737) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2025-09-11 |