NPI | 1497320378 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 85902) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 85902) |
Enumeration Date | 2021-05-24 |
Last Update Date | 2025-07-11 |