| NPI | 1790308807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 8876-851) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125076101) |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2021-07-19 |