| NPI | 1598745721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 270658) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 4217) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2022-07-21 |