| NPI | 1194175224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD476410) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT210906) |
| 2085N0700X Radiology, Neuroradiology (Licence: PA MD476410) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2022-07-26 |