| NPI | 1043391287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MI 4301045120) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301045120) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301045120) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2012-03-21 |