| NPI | 1043203003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 0007352) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 13349-321) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2026-05-04 |