| NPI | 1669030722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC LL82596) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 1017847) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2024-06-27 |