| NPI | 1699158790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A173237) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301107880) |
| 207R00000X Internal Medicine (Licence: MI 5315071121) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2021-08-07 |