| NPI | 1689061459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 2085R0202X) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10052630) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2016-06-17 |