| NPI | 1548883721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 69620) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125076609) |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2021-07-12 |