| NPI | 1629299979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2013-01195) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 390200000x) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2024-09-24 |