| NPI | 1457330516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101238617) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101238617) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0087264) | |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2020-02-11 |