NPI | 1679882591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 51479) |
Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VT 042.0013132) |
207R00000X Internal Medicine (Licence: OH 57017928) | |
Enumeration Date | 2010-09-27 |
Last Update Date | 2021-10-03 |