| NPI | 1902256514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 39768) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL39768) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2018-01495) | |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2023-12-14 |