| NPI | 1730535212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 90837) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.068047) |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2022-08-16 |