| NPI | 1649700931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA DO-06037) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125070386) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2022-07-14 |