| NPI | 1871814616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R3431) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT198213) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A138893) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2025-03-24 |