| NPI | 1144631441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA 14474) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R2371) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2024-03-04 |