| NPI | 1518182500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME109906) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 001963) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2021-01-05 |