| NPI | 1396721817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 22899) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01058104A) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2022-04-15 |