| NPI | 1811438062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 202203319) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC RTL) |
| 208D00000X General Practice (Licence: CA A154485) | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2023-03-10 |