| NPI | 1740667096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 307701) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10054304) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX s8815) | |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2021-12-03 |