| NPI | 1740773282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT215131) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 76466) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 76466) | |
| Enumeration Date | 2018-06-10 |
| Last Update Date | 2024-07-12 |