| NPI | 1679984546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 27689) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT206379) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2021-03-02 |