| NPI | 1710416441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1019342) |
| 207R00000X Internal Medicine (Licence: RI LP03985) | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2024-04-15 |