| NPI | 1306330535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61404278) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 275989) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1014762) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2024-10-14 |