| NPI | 1073003075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S4747) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01082689A) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2022-03-15 |