| NPI | 1396988259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A123678) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125055099) |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2021-12-22 |