| NPI | 1619539749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 11885469-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351045622) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2023-06-07 |