| NPI | 1790139152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2022-00699) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R75524) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2022-09-23 |