| NPI | 1487942413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U2528) |
| Additional Taxonomies | 2085N0700X (Licence: AR E-11328) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2025-02-25 |