| NPI | 1104278688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 32260) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 32260) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2021-10-12 |