| NPI | 1154701654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301501794) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301107224) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2020-06-15 |