| NPI | 1174818967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 060.0004025) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-9228) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-9228) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2016-06-22 |