| NPI | 1609254754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T1296) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10052883) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2022-12-02 |