| NPI | 1558618215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP20039270) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P5104) |
| 208D00000X General Practice (Licence: TX P5104) | |
| Enumeration Date | 2012-08-12 |
| Last Update Date | 2013-01-09 |