| NPI | 1710952601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101006542) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101006542) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2014-07-02 |