| NPI | 1184682551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-13633) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 5924082-1205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A111208) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2018-04-09 |