| NPI | 1174593982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MN 45776) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 45776) |
| 207R00000X Internal Medicine (Licence: WI 54234) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2021-03-29 |