| NPI | 1154710572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: WI 84377-20) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2017-01101) |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2025-06-22 |