| NPI | 1851658520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2015-01726) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 8942) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2025-04-22 |