| NPI | 1386198109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 335473) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301110411) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61266281) | |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2025-05-12 |