| NPI | 1124408620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301504434) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301107230) |
| 2085B0100X Radiology, Body Imaging (Licence: NC 2020-00304) | |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2021-07-15 |