| NPI | 1720516529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 93997) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 009061) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2025-05-19 |