| NPI | 1073937132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MS 28048) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 28944) |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2024-05-02 |