| NPI | 1114587904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2023050265) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125.074488) |
| 207R00000X Internal Medicine (Licence: IL 125074488) | |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2024-06-03 |