| NPI | 1073814141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 10117289-1205) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 208D00000X General Practice (Licence: UT 1234567) | |
| Enumeration Date | 2010-11-05 |
| Last Update Date | 2021-06-15 |