| NPI | 1033520655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 1477) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP61046573) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2025-12-04 |