| NPI | 1992159917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 286860) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 218456) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2023-11-10 |