| NPI | 1972997120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2020-04471) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA OP61330164) |
| 208D00000X General Practice (Licence: NE 1618) | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2024-08-30 |