| NPI | 1154530020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SD 8351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-7921) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2022-03-25 |