| NPI | 1700047800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD14459) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT1938828) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI LPO1680) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2019-04-04 |