| NPI | 1851569701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS10611) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101015859) |
| 208D00000X General Practice (Licence: FL OS 10611) | |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2015-11-12 |