| NPI | 1114211687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT199101) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 51077) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NV 16863) | |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2017-05-23 |