| NPI | 1205404100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301516901) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021020370) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ R79558) | |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2026-07-07 |