| NPI | 1497998967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2013027436) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MO 2013027436) |
| 174400000X Specialist (Licence: MO 2013027436) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2026-06-09 |