| NPI | 1427351097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q7569) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM A-1283-04) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2020-02-27 |