| NPI | 1184328056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ R80111) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R80111) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2024-05-16 |