| NPI | 1174940027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: UT 14212374-1205) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0116027479) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101258688) | |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2025-03-26 |