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 |