| NPI | 1700447836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301511362) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351045664) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2024-07-23 |