| NPI | 1598052623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 21107) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 249294) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME131081) | |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2020-06-04 |