| NPI | 1669972154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MT227795) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101267731) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2023-06-22 |