| NPI | 1205272408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 90901) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 191928) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 56340) | |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2022-06-09 |