| NPI | 1649655192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 30536) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 32142) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2022-04-08 |