| NPI | 1679956817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME142419) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 263930) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2023-03-28 |