| NPI | 1245686898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 95697) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD466052) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2024-04-11 |