| NPI | 1861473498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 027045) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 027045) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2010-03-03 |