| NPI | 1700047842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: CA A109688) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-054386) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A109688) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2014-06-24 |