| NPI | 1235579905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 3001) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT015463) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2022-05-23 |