| NPI | 1861772824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A114489) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A114489) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 258337) | |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2021-12-21 |