| NPI | 1104312909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI DO01312) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5151014051) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 032.0134262) | |
| 207R00000X Internal Medicine (Licence: MA 275719) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 295543) | |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2025-09-18 |