| NPI | 1508206285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2018-01112) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC LL35690) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2021-05-13 |