| NPI | 1013031970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 042767) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 042767) |
| Enumeration Date | 2007-03-18 |
| Last Update Date | 2019-10-01 |