| NPI | 1679134761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 74915) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND RL15850) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2026-01-29 |