| NPI | 1659576171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 239594) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-232476) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA L-232476) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2016-04-20 |