| NPI | 1750518759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME123673) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 46662) |
| 207R00000X Internal Medicine (Licence: TN 46662) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 71515) | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2016-04-11 |