| NPI | 1750812400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A186398) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CA A186398) |
| 207R00000X Internal Medicine (Licence: IL 125.071122) | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2024-07-08 |