| NPI | 1639589401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME145200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301105203) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 55364) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301501046) | |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2024-09-24 |