| NPI | 1124325535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 84292) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 26892) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-02-21 |
| Last Update Date | 2026-05-12 |