| NPI | 1841497757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 14779) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN11374) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2014-01-15 |