| NPI | 1568845667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0116027992) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116027992) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2022-08-08 |