| NPI | 1265624944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M6226) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX M6226) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2016-08-15 |