| NPI | 1184692576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 14268) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 14268) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2015-10-08 |