| NPI | 1881957793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2018014424) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 1584) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2018-07-17 |