| NPI | 1861805046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 208443) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL36890) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2015-08-19 |