| NPI | 1558523878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2018-00655) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 48004) |
| 208D00000X General Practice (Licence: CO 48004) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2020-06-03 |