| NPI | 1083143564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 13154894-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT213910) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2023-01-30 |