| NPI | 1063675197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 25337) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 25337) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 107050) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 57012) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2017-03-06 |