| NPI | 1942863048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V6881) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A182293) |
| 207R00000X Internal Medicine (Licence: TX V6881) | |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2025-05-12 |