| NPI | 1275897902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX R5606) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301100251) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2018-09-27 |