| NPI | 1740592997 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 154458) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL 154458) |
| Enumeration Date | 2010-07-03 |
| Last Update Date | 2024-05-23 |