| NPI | 1821401654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 282303) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 34787) |
| 207R00000X Internal Medicine (Licence: MA 260189) | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2021-01-05 |