| NPI | 1114988086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 00026357) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AL 00026357) |
| 208D00000X General Practice (Licence: AL 00026357) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2008-06-03 |