| NPI | 1053106922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OT024767) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT024767) |
| Enumeration Date | 2025-04-11 |
| Last Update Date | 2026-06-10 |