| NPI | 1154617074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX R2010) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 248859) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2018-03-17 |