| NPI | 1760895676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 36985) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL36985) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2020-04-06 |