| NPI | 1144259086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301070875) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: MI 4301070875) |
| 208D00000X General Practice (Licence: MI 4301070875) | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2015-07-06 |