| NPI | 1619016458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 38534) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 5917) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2022-07-21 |