| NPI | 1225365869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME124347) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57016748) |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2016-04-11 |