| NPI | 1861620486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0055255) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT195318) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2015-07-16 |