| NPI | 1205116506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301507910) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID MRM-1905) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2025-06-30 |