| NPI | 1801274212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD15973) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP03447) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 282604) | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2021-04-08 |