| NPI | 1629515697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 31213) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 31213) |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2026-08-17 |