| NPI | 1063850980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 64275) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R9816) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 28726) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2022-05-23 |