| NPI | 1053540021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 55438-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA ML60093008) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2013-07-09 |