| NPI | 1306043096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: LA 305416) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL29855) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: SC 29855) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2017-12-26 |