| NPI | 1356307136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G48962) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G48962) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2018-07-23 |