| NPI | 1003301037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 67855) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT216782) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2023-07-27 |