| NPI | 1033153812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2006002924) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 006040) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2021-01-08 |