| NPI | 1871855890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 34810) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL34810) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2022-07-21 |