| NPI | 1073775466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E7789) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 20827) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL me180358) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2026-04-21 |