| NPI | 1043747868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-53754) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 7907) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-10-29 |