| NPI | 1235667197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 61467) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 009017) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME159124) | |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2023-01-12 |