| NPI | 1851778096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A145583) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125066552) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2021-07-27 |