| NPI | 1518058171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL DO.396) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL DO-396) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2016-05-03 |