| NPI | 1700014578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 050072) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LPO1706) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 257898) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2018-03-17 |