| NPI | 1033857289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4351049748) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4351049748) |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2022-06-06 |