| NPI | 1861842445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME156289) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP03825) |
| 208000000X Pediatrics (Licence: RI LP03825) | |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2024-09-24 |