| NPI | 1881954501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 29296) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 29296) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: HI MD-23144) | |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2023-03-07 |