| NPI | 1174151369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U6923) |
| Additional Taxonomies | 174400000X Specialist |
| 207R00000X Internal Medicine (Licence: TX U6923) | |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-05-14 |