| NPI | 1285128256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 060.0004846) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.070330) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2023-06-03 |