| NPI | 1457734162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301502121) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301108380) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2020-07-07 |