| NPI | 1982990131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA 61665955) |
| Additional Taxonomies | 2085N0700X (Licence: MI 4301101337) |
| 2085N0700X (Licence: CA C202657) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA12620900) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C202657) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2025-08-20 |