| NPI | 1861830788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0075118) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101256694) |
| 208D00000X General Practice (Licence: CO DR.0075118) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2025-05-28 |