| NPI | 1174976146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2021-01240) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2016018199) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2021-08-31 |