| NPI | 1851850119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL UO6706) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO6706) |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2020-09-02 |