| NPI | 1588822696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2012-00734) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.053489) |
| Enumeration Date | 2008-05-26 |
| Last Update Date | 2021-12-01 |