| NPI | 1700021136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 14878) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14878) |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2018-01-10 |