| NPI | 1245499003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 7852) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 75934) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2025-12-09 |