| NPI | 1013365428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2024-01781) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101272064) |
| 207R00000X Internal Medicine (Licence: PA MT211343) | |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2024-11-06 |