| NPI | 1922412626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-47278) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R10079) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 70591) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-10202) | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2021-04-12 |