| NPI | 1770244634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2026024434) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2025021020) |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2026-06-30 |