| NPI | 1518352020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2021-02274) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 39324) |
| 208D00000X General Practice (Licence: SC 39324) | |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2021-07-10 |