| NPI | 1881981652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: MI 4301099136) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301099136) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2026-02-19 |