| NPI | 1932733953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 5101026381) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101026381) |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2025-08-05 |