| NPI | 1164080222 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 91069) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL82210) | 
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC LL82210) | |
| Enumeration Date | 2019-06-04 | 
| Last Update Date | 2025-07-22 |