| NPI | 1912768268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 25230) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: FL 258436) |
| Enumeration Date | 2024-01-23 |
| Last Update Date | 2026-08-21 |