| NPI | 1457700767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A152476) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.069183) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2021-07-20 |