| NPI | 1083975460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 85210) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 85210) |
| 207R00000X Internal Medicine (Licence: AZ R73381) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ R73381) | |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2025-01-29 |