| NPI | 1245849405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE TEP9162) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT221700) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2021-07-03 |