| NPI | 1164628293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2009-01695) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 5624) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2016-11-18 |