| NPI | 1881041861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX T2402) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10056521) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2022-03-15 |