| NPI | 1164564910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 041262) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 041262) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 041262) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: GA 041262) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2015-10-30 |