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 |