| NPI | 1013404847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA 484710) |
| Additional Taxonomies | 2085N0700X (Licence: SC 82718) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2026-03-26 |