| NPI | 1932356359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 27875) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 5931) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2018-11-08 |