| NPI | 1164951679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 271287) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 271287) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2018-07-05 |