| NPI | 1205403250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 72145) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 17449) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2022-07-15 |