| NPI | 1073602116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 3694A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 16941) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2017-02-02 |