| NPI | 1801380480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101277848) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R11190) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01093379A) | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2024-06-04 |