| NPI | 1245399575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 77006) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101236842) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2021-01-13 |