| NPI | 1235658485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A177364) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 316090) |
| 207R00000X Internal Medicine (Licence: MA 271830) | |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2022-12-29 |