NPI | 1316005143 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 66563) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2000-00713) |
208D00000X General Practice (Licence: GA 66563) | |
Enumeration Date | 2006-12-05 |
Last Update Date | 2018-05-25 |