| NPI | 1174199590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 289621) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 289621) |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2021-05-27 |