| NPI | 1700380169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 58285) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN27058) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2025-06-09 |