| NPI | 1407292527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 55839) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R73778) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2018-06-24 |