| NPI | 1356547756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 40172) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R8039) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2020-10-14 |