| NPI | 1689235848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT221219) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351045638) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2020-06-30 |