| NPI | 1871974543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 273020) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2015017196) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2019-02-17 |