| NPI | 1285861708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101247888) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME126483) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX N9738) | |
| 208D00000X General Practice (Licence: TX N9738) | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2023-08-23 |