| NPI | 1639964273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 48593) |
| Additional Taxonomies | 2085N0700X (Licence: TX 48593) |
| Enumeration Date | 2025-04-14 |
| Last Update Date | 2025-05-22 |