| NPI | 1144584996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A147082) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.060832) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2022-07-21 |