| NPI | 1437710555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1016686) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04765) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2024-06-25 |