| NPI | 1144464801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 074011) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 58839) |
| Enumeration Date | 2009-04-26 |
| Last Update Date | 2025-10-22 |