| NPI | 1477449148 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2026014095) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2025019471) |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2026-06-30 |