| NPI | 1659637767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME130031) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 70590) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 36708) | |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2019-08-31 |