| NPI | 1255679064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 056155) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT AS3501233-M208) |
| Enumeration Date | 2013-01-29 |
| Last Update Date | 2023-03-07 |