| NPI | 1124204623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME110862) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 001595) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2025-09-18 |