| NPI | 1972295855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4351050896) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351050896) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2023-05-23 |