| NPI | 1205498896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME153709) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT219301) |
| 207R00000X Internal Medicine (Licence: FL TRN29832) | |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2023-08-15 |