| NPI | 1952921843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101274497) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101274497) |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2025-08-04 |