| NPI | 1568810802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 53673) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R75691) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2021-07-13 |