| NPI | 1063676807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R7727) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125054416) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A124040) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2024-03-04 |