| NPI | 1457553588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301088482) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301088482) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2026-02-24 |