| NPI | 1306351895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 109881) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A109881) |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2020-05-20 |