| NPI | 1093775520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2017014177) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 36367) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2018-03-17 |