| NPI | 1003064395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: DC MD041651) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT036319) |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2014-10-09 |