| NPI | 1710365291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2020-00042) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10054313) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2021-09-03 |