| NPI | 1902082738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101256136) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 002686) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2014-05-06 |