| NPI | 1700523180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MDRE.ML.61424792) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.079926) |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2023-05-03 |