| NPI | 1699334862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A182251) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019019244) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2024-06-27 |