| NPI | 1760004329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME161513) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN31345) |
| Enumeration Date | 2020-05-17 |
| Last Update Date | 2023-07-05 |