| NPI | 1194164624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 255449) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 83546) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2019-07-11 |