| NPI | 1235492554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 1053) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0064443) |
| 208D00000X General Practice (Licence: NE 1053) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2022-02-04 |