| NPI | 1609122258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 29191) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125060869) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 6887) | |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2022-08-04 |