| NPI | 1629509005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2021-01318) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL40899) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2023-10-27 |