| NPI | 1871153015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 13844180-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 8553) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2024-06-06 |