| NPI | 1750507083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 16738) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16738) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2021-05-03 |