| NPI | 1942049390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT213777) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT231777) |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2025-06-20 |