| NPI | 1740806389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2020016151) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2021020548) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2021-06-21 |