| NPI | 1629631213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4351044266) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351044266) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2020-06-17 |