| NPI | 1265290514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA HS000216L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2025020965) |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2026-06-21 |