| NPI | 1790276079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A173721) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 276542) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2023-07-11 |