| NPI | 1447482724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 6123) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 6123) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2015-05-05 |