| NPI | 1790855674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 36489) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 02003096A) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2025-03-31 |