| NPI | 1912291642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T5937) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P26514) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 060.0004047) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301111737) | |
| Enumeration Date | 2011-05-28 |
| Last Update Date | 2022-05-11 |