| NPI | 1275980864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD465522) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT211061) |
| 207R00000X Internal Medicine (Licence: PA MT211061) | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2023-02-27 |