| NPI | 1164918199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 74110) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND RL15231) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2023-07-24 |