| NPI | 1063418929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX H1561) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H1651) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2024-09-23 |