| NPI | 1467868935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 62158) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL36899) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2019-07-12 |