| NPI | 1760903793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2021-01076) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC LL51211) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 67422) | |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2024-10-24 |