| NPI | 1184627945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301042036) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301042036) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2023-11-09 |