| NPI | 1710154794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 109415) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A119769) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2025-12-12 |