| NPI | 1992124515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 282720) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 260321) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A147399) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-2251) | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2021-05-05 |