| NPI | 1598143943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T1787) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10052922) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2023-12-12 |