| NPI | 1174664163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 25167) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 22687) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 054513) | |
| Enumeration Date | 2007-02-11 |
| Last Update Date | 2016-03-30 |