| NPI | 1114239001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 117285) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125058717) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL TRN16520) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2016-08-22 |