| NPI | 1366868887 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 28780) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61333255) |
| 208D00000X General Practice (Licence: NE 28780) | |
| Enumeration Date | 2014-03-07 |
| Last Update Date | 2024-08-29 |