| NPI | 1083925549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD457200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT196992) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CT 053802) | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2016-05-17 |