| NPI | 1629486824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 1372) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 1372) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 1372) | |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2024-07-03 |