| NPI | 1205219904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301504388) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A166901) |
| 207R00000X Internal Medicine (Licence: MI L801239) | |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2021-07-15 |