| NPI | 1376558205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 39638) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2012-00617) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2026-01-26 |