| NPI | 1285647214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: RI 5355) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: RI MD5355) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2015-09-22 |