| NPI | 1083975460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ R73381) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R73381) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2024-06-13 |