| NPI | 1184129629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 13509681-1205) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01082942A) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2023-08-14 |