| NPI | 1245686815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A172783) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT210646) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2026-01-21 |