| NPI | 1013438266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T4315) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10061528) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2022-07-21 |