| NPI | 1669048401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 6772) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT020903) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2026-06-09 |