| NPI | 1073737540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD060704L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD060704L) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2023-10-20 |