| NPI | 1629259957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101251881) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-052398) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2012-06-13 |