| NPI | 1962997122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 11410657-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 276630) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 276630) | |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2019-09-12 |