| NPI | 1386050250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 322236) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7290) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2020-09-14 |