| NPI | 1235421793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD461801) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT198058) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2017-08-21 |