| NPI | 1174140172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 295306) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA ETLL-1321) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2025-05-21 |