| NPI | 1851852438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A193943) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.073751) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2025-04-07 |