| NPI | 1558472233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME31479) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G87448) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2026-05-18 |