| NPI | 1316203144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX Q3121) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10043168) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NY 297522) | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2021-05-27 |