| NPI | 1508253717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 10077796-1205) |
| Additional Taxonomies | 208D00000X General Practice (Licence: UT 10077796-1205) |
| Enumeration Date | 2015-04-26 |
| Last Update Date | 2024-06-24 |