| NPI | 1578686929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101016618) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302031382) |
| 208D00000X General Practice (Licence: MI 5101016618) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2026-06-03 |