| NPI | 1902164825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10043650) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 13062-320) |
| Enumeration Date | 2012-04-28 |
| Last Update Date | 2026-03-12 |