| NPI | 1134389745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.202077) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA Applying) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2025-05-16 |