| NPI | 1265492342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 045366) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 045366) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2016-09-12 |