| NPI | 1649265364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA MD.07544R) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: LA MD07544R) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2015-06-01 |