| NPI | 1467839811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2020-00347) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 209423) |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2021-07-13 |