| NPI | 1891786430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 57282) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 57282) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2012-07-24 |