| NPI | 1548554587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2014-01081) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT200149) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A140811) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2020-09-12 |