| NPI | 1992366579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A176728) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 280836) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2024-06-25 |