| NPI | 1255591343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 48931) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 70465) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: AZ 48931) | |
| 2085B0100X Radiology, Body Imaging (Licence: AZ 48931) | |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2014-07-24 |