| NPI | 1215678834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 69415) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R79399) |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2023-10-03 |