| NPI | 1871101048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0076917) |
| Additional Taxonomies | 2085N0700X (Licence: CO DR.0076917) |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2026-04-21 |