| NPI | 1841309515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MT 48128) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MT 7755) |
| 207Q00000X Family Medicine (Licence: MT 7755) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2018-06-21 |