| NPI | 1538264106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL os 1683) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL os1683) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2015-05-04 |