| NPI | 1679712251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 4429) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 102204985) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 2416) | |
| 208D00000X General Practice (Licence: WV 2416) | |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2022-10-21 |