| NPI | 1376711234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 018493) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DC 040569) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2013-12-09 |