| NPI | 1265789457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 61548) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 251637) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2020-08-14 |