| NPI | 1316332174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A169090) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL L.4226R) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 89308) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2021-06-23 |