| NPI | 1871796508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X (Licence: TX R2584) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0069593) |
| 208D00000X General Practice (Licence: IN 01065944A) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2023-03-23 |