| NPI | 1104851872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X (Licence: NE 12181) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: NE 12181) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2025-09-11 |