| NPI | 1205120045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301110318) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.059533) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5315077054) | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2022-07-21 |