| NPI | 1518526094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 60583) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 8484) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2024-04-30 |