| NPI | 1639609829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101280429) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125071386) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125-071386) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2024-03-21 |