| NPI | 1619590536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A190029) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL84197) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2025-09-09 |