| NPI | 1801351457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 2260) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP61538446) |
| 208D00000X General Practice (Licence: NE 2260) | |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2024-08-30 |