| NPI | 1023215464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 28513) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 51128) |
| 207R00000X Internal Medicine (Licence: NE 5621) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 8798) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2018-10-15 |