| NPI | 1730547787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 286226) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101263002) |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2023-08-15 |