| NPI | 1063030021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4351049961) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4351049961) |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2026-05-21 |