| NPI | 1114667193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 69465) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R79381) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2023-09-27 |