| NPI | 1851779706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: NC 2019-01412) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 85836) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2025-10-21 |