| NPI | 1679839559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 282700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 282158) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2020-07-09 |