| NPI | 1265625347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 45750) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 25836) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 25836) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2014-07-29 |