| 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 |