| NPI | 1871792341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: PA MT201961) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301090575) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD445816) | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2013-05-16 |