| NPI | 1558655050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101261887) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 248925) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0079202) | |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2017-08-02 |