| NPI | 1942415567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: NC 2005-00908) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2005-00908) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2025-09-30 |