| NPI | 1720601800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4351046550) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351046550) |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2020-05-22 |