| NPI | 1043654015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: HI MD-19702) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD61584018) |
| 208D00000X General Practice (Licence: PR 030043) | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2024-09-19 |