| NPI | 1942689450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 75269) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT209134) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2021-11-30 |