| NPI | 1841557279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 10112241-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT201188) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2018-06-14 |