| NPI | 1326624172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID 4971488) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD228186) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL TRN32772) | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2026-05-07 |