| NPI | 1922361070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD463773) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT201107) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2018-11-07 |