| NPI | 1558657569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 34754) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 4779) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2016-06-17 |