| NPI | 1568749935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 292275) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301098911) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301098911) | |
| Enumeration Date | 2011-11-13 |
| Last Update Date | 2022-06-29 |