| NPI | 1396701165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD442272) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 2085R0202X) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2025-07-25 |