| NPI | 1952536492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME115312) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN13772) |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2016-01-27 |