| NPI | 1619176187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 60772) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301090023) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2021-07-10 |