| NPI | 1801156518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 56162) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 29334) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 269474) | |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2018-03-17 |