| NPI | 1528588621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 67313) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10061530) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 65963) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2023-05-01 |