| NPI | 1821470980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD182649) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IA R-10326) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2020-07-10 |