| NPI | 1285071142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 281142) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT204249) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2019-09-13 |