| NPI | 1679591143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 43100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 18627) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-04-15 |