| NPI | 1598787798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL OS6377) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA OS8012L) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OR DO25896) | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: OH 012031) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2023-03-07 |