| NPI | 1285016733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 37698) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL37698) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2020-09-15 |