| NPI | 1548589674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX Q7713) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 7390) |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2017-03-09 |