| NPI | 1871931667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60676520) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 21964) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2025-10-02 |