| NPI | 1588387161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL MFC1856) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: FL 1856) |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2025-06-03 |