| NPI | 1265051338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 33776) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 33776) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2025-05-12 |