| 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 |