| NPI | 1134566102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0014254) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT-203745) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2019-04-09 |