| NPI | 1346312931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 14743) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 98612) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2025-12-03 |