| NPI | 1336551993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: OR MD219482) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 73184) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2026-03-09 |