| NPI | 1023570827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS17493) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO6781) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL UO6781) | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2021-08-02 |