| NPI | 1245724343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10067141) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125072099) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2019-08-18 |