| NPI | 1568027860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME174313) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V9625) |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2026-09-21 |