| NPI | 1912167305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME124559) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01070197A) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 57001) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2023-08-16 |