| NPI | 1003680174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-00766) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 233344990000) |
| Enumeration Date | 2023-11-09 |
| Last Update Date | 2025-06-11 |