| NPI | 1114377983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T4918) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT211608) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A154617) | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2023-03-16 |