| NPI | 1720725880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 3015004) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT226967) |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2023-06-16 |