| NPI | 1376995225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301504502) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301110742) |
| Enumeration Date | 2016-07-04 |
| Last Update Date | 2021-11-24 |