| NPI | 1578822052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: NC 2020-00270) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 11017347A) |
| 207R00000X Internal Medicine (Licence: TX BP10043739) | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2026-04-13 |