| NPI | 1811275266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-02086) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 109903) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 2635910) | |
| 207R00000X Internal Medicine (Licence: MA 2635910) | |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2025-10-08 |