| NPI | 1073170528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1021841) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R11480) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A181018) | |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2025-06-18 |