| NPI | 1780648212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 18187) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL 18187) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2020-12-22 |