| NPI | 1952539629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 28467) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 6214) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NE 6120) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2011-07-04 |