| NPI | 1902369788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL DO.2490) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2024-02495) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2025-08-28 |