| NPI | 1518317569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: GA 90527) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NC 2021-00816) |
| 208D00000X General Practice (Licence: SC LL35909) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2022-05-19 |