| NPI | 1801380647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1015562) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT215284) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2023-06-06 |