| NPI | 1063732972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD14033) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP02007) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 277015) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 14033) | |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2019-03-18 |