| NPI | 1457650079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 255258) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10040628) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2013-08-12 |