| NPI | 1295317972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD487585) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD487585) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2025-01-03 |