| NPI | 1790722767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX D5478) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX D5478) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2017-02-01 |