| NPI | 1700012861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 83445) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 157160) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2015-0218) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA ML60165706) | |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2020-04-09 |