| NPI | 1306166657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 32697) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL32697) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 262305) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2016-06-21 |