| NPI | 1538455068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 281386) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A123679) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2019-11-22 |