| NPI | 1881613586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A81760) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L9533) |
| 208D00000X General Practice (Licence: VA 0101252002) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2022-04-15 |