| NPI | 1023277654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 245910) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-236085) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2014-10-06 |