| NPI | 1609803162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 55152) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 26551) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2019-10-23 |