| 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 |