| NPI | 1619298965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A119317) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT196633) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2023-04-25 |