| NPI | 1164822607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: CA C23563) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C23563) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2014-09-03 |