| NPI | 1881633634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ND 4455) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 4816) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-03-25 |