| NPI | 1760777650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0082749) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199191) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD044803) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D90151) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD456112) | |
| Enumeration Date | 2011-06-18 |
| Last Update Date | 2020-04-25 |