| NPI | 1508217050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A172762) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R10617) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2021-07-01 |