| NPI | 1164733622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 278423) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT197699) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2016-05-19 |