| NPI | 1740419431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2012020291) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2012020291) |
| 207R00000X Internal Medicine (Licence: MO 2012020291) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2023-11-14 |