| NPI | 1164080222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 91069) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL82210) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC LL82210) | |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2025-07-22 |