| NPI | 1710060595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL 106927) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL 26285) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2016-04-11 |