| NPI | 1710366463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 88107) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT209280) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2022-07-06 |