| NPI | 1306109905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A148942) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R9512) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2022-06-09 |