| NPI | 1093154056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 263206) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 255651) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 255651) | |
| Enumeration Date | 2013-06-22 |
| Last Update Date | 2015-08-04 |