| NPI | 1629172317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301031888) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301031888) |
| 207RI0011X Internal Medicine Interventional Cardiology (Licence: MI 4301031888) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2012-08-28 |