| NPI | 1073682720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61036369) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01062671A) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2022-01-04 |