| NPI | 1942763420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101282665) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID MRM-1803) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 11901378-1205) | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2024-07-01 |