| NPI | 1639432818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 226352) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301100419) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2018-01-31 |