| NPI | 1619270386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042.0013086) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP02031) |
| Enumeration Date | 2010-12-17 |
| Last Update Date | 2016-06-08 |