| NPI | 1942681549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S9105) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT209406) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2022-03-30 |