| NPI | 1780876649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101277344) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 20451) |
| 207R00000X Internal Medicine (Licence: LA PGY.EKL.INTMED9021) | |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2023-07-25 |