| NPI | 1538591896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 05387) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.063391) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 36678) | |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2021-01-19 |