| NPI | 1447748736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101283677) |
| Additional Taxonomies | 2085N0904X (Licence: UT 14215651-1205) |
| 208D00000X General Practice (Licence: VA 0101283677) | |
| 207U00000X Nuclear Medicine (Licence: VA 0101283677) | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2025-11-25 |