| NPI | 1043530215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: MI 5101016628) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101016628) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2025-03-19 |