| NPI | 1750377925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C40893) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME60710) |
| 208D00000X General Practice (Licence: FL ME60710) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2025-08-15 |