| NPI | 1770878001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME129889) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R9277) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2017-10-05 |