| NPI | 1922785369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC LL90316) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 49794) |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2026-01-31 |