| NPI | 1376922898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD473531) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT208054) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2022-11-15 |