| NPI | 1023429495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 35318) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL 35318) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2023-06-01 |