| NPI | 1801848387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60222575) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 052452) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2025-10-30 |