| NPI | 1720084726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX J4036) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX J4036) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2019-06-03 |