| NPI | 1609304070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61282818) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10060352) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2023-04-24 |