| NPI | 1912292046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60818531) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.059524) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MA 261062) | |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2020-04-01 |