| NPI | 1962780742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD457269) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199861) |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2016-08-31 |