| NPI | 1740819812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC LL86177) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 261546) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2026-07-09 |