| NPI | 1306106562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0059707) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10043077) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2019-01-10 |