| NPI | 1316209513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 34753) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL34753) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2020-11-13 |