| NPI | 1184154296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 291673) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 272552) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 272552) | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2022-07-11 |