| NPI | 1548501554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 35858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 35858) |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2013-03-15 |