| NPI | 1508020736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q1020) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 11991-I) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 240004) | |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2020-04-07 |