| NPI | 1104231430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-47317) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R10123) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 70862) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R10123) | |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2021-05-05 |