| NPI | 1104231687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME DO2974) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101022053) |
| 208D00000X General Practice (Licence: MI 5101022053) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2021-11-10 |