| NPI | 1932494390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SD 11534) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 6495) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MN 106274) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MN 55600) | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2023-08-29 |