| NPI | 1043565500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD15785) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301101132) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2022-07-21 |