| NPI | 1881076073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A167826) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 7548) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 650923) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2020-07-08 |