| NPI | 1710280219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME150914) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.018347) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 64234) | |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2021-11-02 |