| NPI | 1578851192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD H0085142) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT014195) |
| Enumeration Date | 2011-07-17 |
| Last Update Date | 2018-07-06 |