| NPI | 1386718625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 21050) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 21050) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2018-10-30 |