| NPI | 1760572895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0005116) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 9400769) |
| 208D00000X General Practice (Licence: AZ 42721) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2017-02-23 |