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 |