| NPI | 1295904159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: LA MD.202925) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA PGY.1.LSUNO-IM) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2013-11-12 |