| NPI | 1508098948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 54455) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01068794A) |
| Enumeration Date | 2009-08-19 |
| Last Update Date | 2018-02-20 |