| NPI | 1821290644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD14120) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP01168) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 254498) | |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2019-03-12 |