| NPI | 1609005289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 45051) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R71660) |
| Enumeration Date | 2009-07-05 |
| Last Update Date | 2021-11-05 |