| NPI | 1912386970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX S9697) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT016631) |
| Enumeration Date | 2015-05-23 |
| Last Update Date | 2022-03-28 |