| NPI | 1174753982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2015043933) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2009020446) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME112133) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2021-04-08 |