| NPI | 1821039025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: ID M5502) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M5502) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2014-03-12 |