| NPI | 1861594509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 25501) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: KY 25501) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2016-11-22 |