| NPI | 1891134193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME134589) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R74074) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2018-06-25 |