| NPI | 1346537891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 22575) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MS 22575) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2017-06-29 |