| NPI | 1902217227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: MI 4301504223) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301504223) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2025-07-28 |