| NPI | 1750516415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 27186) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 27186) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2017-05-18 |