| NPI | 1801044714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 63909) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 35228) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2013-08-29 |