| NPI | 1912358318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0015695) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 268556) |
| 207R00000X Internal Medicine (Licence: MA 268556) | |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2022-07-15 |