| NPI | 1861628612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD456763) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT194993) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2015-12-30 |