| NPI | 1073174694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 67910) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND RL15753) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2025-07-03 |