| NPI | 1407207236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS15272) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL uo5229) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 69023) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2021-08-03 |