| NPI | 1376839118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101259853) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC LL 33537) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2022-07-21 |