| NPI | 1992149835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 61493) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 6240) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2024-03-31 |