| NPI | 1407606429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2025019996) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.083274) |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2025-06-20 |