| NPI | 1720878671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 102208851) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.085596) |
| Enumeration Date | 2025-05-12 |
| Last Update Date | 2026-06-11 |