| NPI | 1255659389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101251133) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A153128) |
| 208D00000X General Practice (Licence: VA 0101251133) | |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2020-07-17 |