| NPI | 1073716072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 52902) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R8049) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2018-10-01 |