| NPI | 1760610380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 36732) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 003550) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2015-03-09 |