| NPI | 1952494585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: MT 5340) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 5340) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-09-17 |