| NPI | 1427671924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: MI 4301507718) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4351046207) |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2025-06-15 |