| NPI | 1801235395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 49699) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R74078) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2022-09-06 |